Healthcare Provider Details

I. General information

NPI: 1538866470
Provider Name (Legal Business Name): DIANNA MICHELLE MEJIA DC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DIANNA MICHELLE AMARAL

II. Dates (important events)

Enumeration Date: 02/10/2023
Last Update Date: 02/10/2023
Certification Date: 02/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9217 W US HIGHWAY 290 STE 150
AUSTIN TX
78736-7818
US

IV. Provider business mailing address

113 MOUNT ORD LN
DRIPPING SPRINGS TX
78620-2241
US

V. Phone/Fax

Practice location:
  • Phone: 512-222-4222
  • Fax:
Mailing address:
  • Phone: 209-628-9974
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number15448
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: